The first of three reviews carried out at University Hospitals Birmingham NHS Foundation Trust, found issues around leadership, culture and staff welfare - which if not improved, have potential to put the care of patients at risk.
Extensive complaints were made about the organisations conduct and its “toxic atmosphere and bullying at all levels of management".
The first of those three reviews, focusing on patient safety and governance, also followed the conclusion of an inquest into the suicide of a junior doctor, Dr Vaishnavi Kumar, who worked at Birmingham's Queen Elizabeth Hospital and had said she felt 'belittled' at work.
In December 2022, the NHS announced there would be three reviews carried out by Professor Mike Bewick, former National Deputy Medical Director at NHS England - commissioned by the Birmingham and Solihull Integrated Care Board.
The review says its overall view is that the Trust is a "safe place to receive care, but any continuance of a culture that is corrosively affecting morale and in particularthreatens long term staff recruitment and retention will put at risk the care of patients across the organisation – particularly in the current nationwide NHS staffing crisis".
What areas of concern did the review highlight?
Cultural problems at the Trust require serious attention. Views given by members of the Queen Elizabeth Hospital Senior Medical Staff Committee are 'highly significant', including bullying, poor communication, lack of clinical leadership and services compromised through questionable leadership.
There is a raised mortality rate of 110, which is 'significant' compared to other organisations - it's an indicator of healthcare quality that measures whether the number of deaths is higher or lower than expected.
Low staffing levels, particularly at Good Hope Hospital in Sutton Coldfield.
The initial goodwill of cooperation from the Trust has dissipated and is culturally very reluctant to accept criticism or acknowledge adverse views expressed by the review and other significant external bodies.
What recommendations has the review made?
The review team make 17 recommendations across clinical safety, governance and leadership, staff welfare and culture, including:
That the Trust commissions a partner to deliver awareness training on how to identify issues of bullying, coercion, intimidation and misogyny.
A specific review of mortality should be conducted by an external specialist in this field with support from a governance lead.
That prospective appointments of senior medical, nursing, and managerial leadership are reviewed with a focus on developing core skills, including those required for leadership, collaborative working methods, professional interaction, and disciplinary processes.
In light of the suicide of Dr Kumar - a review of the processes to support doctors in training who are concerned about their mental health, ability to speak up freely about concerns with colleagues and a clear message that they will be listened to.
That the concerns of senior clinicians, expressed by the Medical Staff Committee in January 2023, are addressed specifically as part of the Phase 2 cultural review.
Jonathan Brotherton, Chief Executive at University Hospitals Birmingham NHS Foundation Trust, said: “Patients can continue to be confident that the care and treatment provided at our hospitals is safe. We are pleased that Prof Bewick’s overall view ‘is that the Trust is a safe place to receive care’.
“We fully accept his recommendations and welcome the additional assurance that has been asked for through further independent oversight.
“There are a number of significant concerns that we need to, and have started to, address; we will continue to learn from the past, as we move forward.
“We want to develop a positive, inclusive work environment where people want to come to work, in a place that they are proud to work in, to do their very best for our patients. While we will not be able to fix things as quickly as I would like, we do need to do it as quickly as possible, for the benefit of patients and staff; I am committed to ensuring this happens.
“We must now focus on continuing to provide the best possible patient care, building a values-led culture and supporting our incredible colleagues.”
Professor Mike Bewick, Lead Reviewer, said: “Our rapid review has found that services at University Hospitals Birmingham are safe and patients should be confident when using them. We have, however, confirmed some, but not all, of the concerns made on the Newsnight programme in December of last year. In response to their concerns and those raised by Healthwatch, Preet Gill and many other individuals who have come forward, we have made several recommendations for further investigation and action.
“We have been disturbed by the consistent reporting of a bullying culture at the Trust and look forward to the next phase of the review where staff and patients will have the opportunity to speak freely and confidentially about their concerns. I know that Dame Yve Buckland, the Interim Chair at UHB, is already addressing these concerns and I thank her for her support during our review.”
In response to the report, the chief executive of the University Hospitals Birmingham, Jonathan Brotherton said he fully accepted its findings.
He said: "We are listening, I am listening, I have done so much listening, so much engagement about all of the things that people are unhappy about in this organisation. I am commited to making sure that we change. We've got to support our staff they do amazing things, they will do even better things if we can further make changes to the culture and the way that it feels to work in the organisation."